Laparoscopic approach for suspected early-stage gallbladder carcinoma.

OBJECTIVE To determine the feasibility of the laparoscopic approach for treating suspected early-stage gallbladder carcinoma. DESIGN, SETTING, AND PATIENTS Prospective study from a university hospital. From May 10, 2004, to October 9, 2007, the laparoscopic approach was considered for treating 36 patients with suspected gallbladder carcinoma at T2 or less without liver invasion based on the preoperative computed tomographic scan. To further exclude liver invasion, preoperative endoscopic ultrasonography (US) and laparoscopic US were additionally performed. Frozen biopsy was performed after completing the cholecystectomy. If carcinoma was found, laparoscopic lymphadenectomy was performed. MAIN OUTCOME MEASURES Feasibility and operative outcome. RESULTS Three patients who had liver invasion on endoscopic US underwent open surgery. An additional 3 patients who had liver invasion noted on laparoscopic US had their surgical procedure converted to laparotomy. Finally, 30 patients underwent a laparoscopic procedure. With combined computed tomography, endoscopic US, and laparoscopic US, the negative predictive value for excluding hepatic invasion reached 100%. For the 12 patients who had benign lesions noted on their frozen biopsies, their laparoscopic surgical procedure was completed. The remaining 18 patients who had gallbladder carcinoma underwent additional laparoscopic lymphadenectomy. During laparoscopic lymphadenectomy 1 conversion occurred owing to bleeding, the median operative time was 190 minutes, and the median blood loss was 50 mL. The complication rate was 16.7% and the median postoperative hospital stay was 4 days. After a median follow-up of 27 months, all 18 patients who underwent laparoscopic lymphadenectomy survived without any evidence of recurrence or metastasis. CONCLUSION Laparoscopic treatment is feasible and safe in selected patients with early-stage gallbladder carcinoma.